Peripartum Hysterectomy

Abstract

Objective: To find out the frequency, indication & its associated morbidity in our setup. Study design: Prospective cross-sectional observational study for the period one year (from June 2003 —May 2004) carried out in the Department of Obs/ Gynae, Lahore General Hospital Lahore. Results: During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery & 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases (46.15%). Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6(23.07%) of cases. In 19.2% (5) of cases abnormal placentation was the cause. In 2(7.6%) of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 (38.46%) & total hysterectomy was performed in 16 (61.53%) cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3(11.53%) cases, fever, chest infection & wound infection were common morbidity. Anemia was found in almost every case. Intra & post-operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Conclusion: Despite its morbidity & mortality emergency Obstetric hysterectomy remains an essential life-saving tool Uterine atony, uterine rupture & abnormal placentation were mast common indications, reflecting under-utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty & delayed referral all contribute to morbidity & mortality associated with emergency Obstetric hysterectomy.